Contagion risk remains high as Italy gets ready to reopen

Italians are preparing for the first stage in lifting coronavirus restrictions on May 4 [Jennifer Lorenzini/Reuters]

Turin, Italy - As Italy prepares to take the first step on Monday to lift the lockdown imposed nearly two months ago to stem the coronavirus pandemic, tensions are mounting.

Prime Minister Giuseppe Conte has opted for a nationwide reopening, rather than lifting restrictions region by region, taking into account the distribution of infection clusters. And it's a plan that is not without its critics.

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"Thanks to the sacrifices done until today we have managed to contain the spread of the epidemic. This is a great result," Conte said on Sunday.

"We are about to enter the phase of coexistence with the virus, and we need to be aware that during this phase the contagion curve could climb back in some areas. We need to speak honestly. This risk exists, but we need to face it with strategy and rigour."

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Italy was among the first European countries to impose strict restrictions, shutting down much of normal life on March 10. The country's total death toll has climbed to over 28,000 - the second highest in the world after the United States - with more than 200,000 cases confirmed so far.

But come May 4, some 4.5 million workers will return to work, and many of them in the areas hardest hit by the pandemic.

Reopening schedule

Manufacturing, construction companies and some wholesalers will resume operations on Monday, but movement between regions remains forbidden, leaving it up to each territory to monitor changes and trends in infection rates. Parks will reopen across cities, with individual exercise allowed. Takeaway businesses will also be firing up their kitchens once more.

Limited family visits will be permitted, though religious ceremonies remain suspended - with the exception of funerals, which can only be performed with 15 people or fewer in attendance. Meanwhile, citizens will still be discouraged from travelling freely, with everyone being asked to carry a formal declaration giving the reasons for their being outdoors in order to avoid sanctions.

Shops, museums and libraries will reopen on May 18. Restaurants and bars will be allowed to start trading early in June. Schools will remain shut until September.

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Although the burden on hospitals - particularly intensive care units - has steadily decreased, the numbers of infections and deaths fail to meet the criteria for reopening recommended by the European Commission, said Italy's Group for Evidence-based Medicine, known as GIMBE, its acronym in Italian.

Eighty percent of new cases and deaths recorded between April 22 and 29 were in five northern regions, according to the National Health Institute. Those regions are also Italy's most industrialised areas and the engines of the country's economy. They have been the areas hardest hit by the outbreak.

"It is clear that those who risk more here are those regions that have a number of cases and a percentage growth which are still not sufficiently under control," Nino Cartabellotta, a public health expert and president of GIMBE, told Al Jazeera.

"From a scientific point of view," he said, "it would have been much more logical to open the country based on the different geographic areas."

The researcher says the government's decision was most likely the result of a political compromise.

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"Northern regions have pushed and are pushing for the opening to reignite their production engines, on the other hand, southern regions did not, and don't want interregional mobility to spread contagion. This is the result of a political approach instead of a scientific one," Cartabellotta said. Less pressure on hospitals and ICUs is crucial in being able to face possible new surges in the contagion, he added.

'We didn't have a choice'

According to the International Monetary Fund, eurozone economies will contract by 7.5 percent in 2020, with Italy suffering a fall in GDP (gross domestic product) of 9.1 percent. Fitch Ratings have, meanwhile, downgraded Italy's credit rating by a notch to BBB-, just one level above non-investment grade, also known as junk.

Entrepreneurs in the north have been preparing to ready their business premises for the reopening, while some resumed operations last week after being granted formal permission.

"We had to reopen, we didn't have a choice. I closed the activity having plenty of orders," said the owner of one engineering factory who asked to remain anonymous. In Piedmont's Alessandria, home to his factory, the case rate is still growing by 13.7 percent on a weekly basis. "If those orders [aren't fulfilled by] me," the owner said, "my clients would go somewhere else."

Around 80 people are employed in the factory, which was fully sanitised before its reopening. All machines and equipment are cleaned thoroughly at the end of each shift. All health protocols and guidelines provided by the government, in addition to further safety measures, have been implemented.

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"We take the workers' temperature at the entrance of the premises and have put signs all over the area to indicate the distance workers must stick to," the owner says. "We also give gloves and masks at the entrance and implement staggered entries and exits for the workers."

Posters showing the correct health and safety measures to be adopted dot the premises' walls. Drivers must have a certification of good health and cannot leave their vehicles. And if they must, they have to remain close to their trucks.

"Next week, we will also start serological tests among the workforce in order to isolate possible infections and refer people to the local health authorities," the owner continued. "I was afraid workers would not come to work amid fears of the contagion. But everyone was there and no one complained. It shows Italy wants to restart its engines."

Reopenings 'on a scientific basis'

Small businesses and shop owners across Italy have been chomping at the bit in recent days for a possible reopening, especially in those central and southern regions where limited numbers of infections have been recorded.

Thousands of bars and restaurants across the country took part in a coordinated protest on Tuesday, symbolically opening their doors at 9pm, turning on their lights and laying tables, showing their readiness to reopen and highlighting the huge economic losses they continue to face during the ongoing lockdown.

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While the southern regions have on the whole not been pushing for an immediate return to business as usual, some challenges to the government's softly-softly approach are popping up.

The governor of the southern region of Calabria, where some 1,100 cases have been recorded, has announced bars and restaurants would be allowed to reopen outdoor areas as of April 30. But the move received a lukewarm response among local mayors.

Conte, meanwhile, declared such moves "entirely illegitimate".

"Further reopenings will be considered in the next few hours but always on a strictly scientific basis, not on the basis of sudden initiatives taken by local authorities," Conte told Parliament on Thursday. He went on to acknowledge the vast economic damages the lockdown was bringing to many sectors, but still declared that both retail and recreational activities would only restart when scientific analysis would allow.

Structured roadmap

Meanwhile, some of the worst-hit cities continue to prepare for the reopening on Monday.

The office of the mayor of Cremona, one of the epicentres of the crisis in the Lombardy region, with some 6,000 infections of a population of 70,000, told Al Jazeera they were working on a structured road map to be able to reopen in a manner to guarantee citizens' safety.

Lombardy has borne the brunt of Italy's contagion, with more than 13,500 deaths due to coronavirus.

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Cremona plans to reopen a local street market, with staggered entrances and exits to avoid a concentration of people, and stalls placed a safe distance apart.

But local authorities want more measures implemented at national and regional levels to stem the risk of contagion.

Scorched by the impact of the epidemic across their territories, mayors of the region wrote to regional and national officials on Thursday, asking for clarification on the availability of serological and swab tests and contact tracing methods to help prevent contagion and swiftly isolate new cases.

Conte said 150,000 serological tests would be made available by the government in the coming weeks to obtain a more complete picture of the epidemic's spread in the country. A tracing app, which won't retain users' personal data, will soon be introduced, he added.

"Although the reopening poses higher risks in certain regions, which can still be considered in the first phase of the epidemic, the government has still opted for a cautious choice," Cartabellotta, the public health expert, said. "The next steps will be taken in two weeks. By that time, we will know about a possible new surge in contagion. I would have reopened new activities after three weeks, but it was probably impossible to do so from a political and economic perspective."

Protective measures

Scientists in Italy agree this first phase should see the compulsory use of protective masks for all, especially considering that the role played by asymptomatic carriers in spreading the infection is now clear.

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Conte said his government would make face masks available and cap prices at 50 euro cents ($0.55), although retailers have complained that did not mirror their market price.

New safety measures to protect workers during their commutes are being planned. Alternative transportation such as bicycles are being promoted, with cities adapting roads for an increased number of cyclists and increasing space to allow pedestrians to maintain social distancing.

How to maintain safe distancing on trains and buses, and more frequent routes, are under discussion. Vending machines selling masks and hand sanitiser are due to be installed at bus stops and train stations, authorities said.

"Some of these measures have also a symbolic value," Giulio Mattioli, a research fellow with TU Dortmund University, told Al Jazeera.

"Asking people on public transport to maintain a one-metre distance between each other is something [which is] challenging to stick to at all times," said Mattioli. "Still, such norms could [be of] value as a collective perception measure. In this way people would at least tell each other to keep at some distance."